ACUTE PROSTATITIS AND HYPERÆMIA OF THE PROSTATE.
Causes: In dogs, house life, overfeeding, compulsory retention of urine, and fæces, constipation, proctitis (rectitis), piles, calculi, strangury, uric acid, urethral ulceration or stricture, rude catheterization, chill, generative excitement to excess, secondary abscess or infection. Forms. Lesions: follicular, interstitial, circumscribed and diffuse suppuration. Symptoms: frequent straining urination, rectal palpation, incontinence of urine, costiveness, tender perineum, dullness, recumbency, fever, pus in urine, collapse of swelling, fistula. Diagnosis. Prognosis: grave. Treatment: laxatives, mercurials, salines, leeches, acid laxative, non-stimulating, camphor, bromides, ergot, witch hazel, opium, belladonna, enemata of cold water, or ice suppository, catheterization, perineal incision, antiseptics.
Causes. This is most commonly seen in dogs, in which it may depend on house life with overfeeding on stimulating, spiced, albuminous food, compulsory restraint of urination and defecation in obedience to the demands of cleanliness, distended bladder, and rectum, constipation, proctitis, piles, and other sources of local irritation. In all animals its origin is favored by the formation or arrest of calculi in the prostate, the pelvic urethra or even the bladder; by drug strangury from cantharides or other irritant diuretic; by excess of urea, uric acid or other irritant in the urine; by infection extending from the urethra or bladder; by ulceration or stricture of the urethra; by rude or incautious catheterization, or injection; by exposure to cold; and by local infection in pyæmia and other general zymotic disorders. Most of these conditions conduce to local excitement and hyperæmia, which from adjacent organs, are sympathetically transferred to the prostate. The same is true of frequent, and intense generative excitement which according to Lafosse and Cadiot is a common cause of prostatitis in stud horses. Again the abscess of strangles may become localized in the prostate, or the nodule of glanders, or the tubercle of tuberculosis (cattle, pigs, dogs). Cadiot suggests that in animals, divested of the tail, external injuries to the perineum may extend by continuity to the prostate, as happens to man from horseback or bicycle riding. He adduces no cases however. The habit of masturbation acquired by certain males may also be adduced theoretically as both cause and consequence of prostatitis but future observation must show how frequently this really operates.
Forms. Lesions. According to the nature of the lesions the affection has been divided into different forms 1st, Follicular or Parenchymatous; 2d, Diffuse or Interstitial; 3d, Circumscribed Prostatic Abscess; 4th, Multiple Miliary Abscesses.
Follicular Prostatitis implicates primarily the follicles and gland ducts and finally the entire gland tissue. It is usually associated with and doubtless often proves an extension from an adjacent infective urethritis, and tends, in persistent cases, to go on to interstitial inflammation and abscess, or hypertrophy. This is characterized by more or less swelling of the prostate, with increased vascularity of its mucosa and the oozing from its openings and gland ducts under pressure, of a thick, yellow, gelatinoid fluid containing pus and granular epithelial cells and sometimes striæ of blood.
Diffuse (Interstitial) Prostatitis shows, in addition to the general swelling and muco-purulent discharge, a considerable exudate into the interstitial tissue, with increased tension and resistance of its substance. It is associated during life with more fever and constitutional disturbance than the simple catarrhal or follicular form.
In Circumscribed Prostatic Abscess we find, in addition to the general hyperæmia and swelling, a much more prominent local swelling, the seat of intense inflammation, at first firm and resistant and later softer and fluctuating in the centre, which is filled with pus. This may have its origin in the follicular form, the pus becoming shut up in a follicle and gradually increasing until it bursts into the urethra, the bladder, the rectum, the peritoneum, or pelvic fascia and perineum. In other cases it becomes complicated by pyæmia and secondary abscesses.
Miliary Abscesses may be comparatively few in number or generally diffused through the prostate, and are often the result of a pre-existing general infection.
Symptoms. As the disease usually begins as a local infection the first symptoms are, as a rule, unattended by fever, which, however, appears in two or three days as the local lesions increase. The urine may be passed frequently in small amounts, or there may be frequent straining without passage of urine, the pressure of the swollen prostate, with or without spasm of the sphincter vescicæ, causing retention. It is no uncommon thing to find the last urine passed of a milky or glairy character and, coagula moulded in the prostatic canals may at times be found. The presence of spermatic crystals, fusiform, with very pointed extremities, and precipitated on the addition of ammonium phosphate, is characteristic of prostatic fluid, (Fürbringer). In other cases there is incontinence, the urine dribbling away involuntarily as the animal walks, and especially if anything occurs to excite him. Micturition may be painless or attended by acute suffering, which causes a sudden arrest of the flow. Defecation is attended with difficulty and more or less pain, and obstinate constipation is likely to set in. The animal is dull, spiritless and seeks to lie undisturbed. Pressure on the perineum is painful and exercise aggravates the symptoms. Rectal examination by the hand or finger according to the size of the animal, reveals the enlarged, tender prostate lying on the cervix vesicæ. This swelling may be unilateral but most commonly it is bilateral or general. When fever sets in with a temperature of 102°–104°, thirst, anorexia and weakness or stiffness in the hind parts may be noticed. In case of abscess, the urine may be perfectly clear until it bursts into the urethra or bladder when there is an abundant flow of pus, and rectal examination shows that the swelling and tension have notably diminished. Should it burst into the rectum, the pus shows in the fæces. Reinemann records a case in a bull with dysuria, œdema of the sheath and a swelling like the fist in the perineum, containing pus, and which communicated with the prostate and urethra. With the rupture of the abscess there is a marked amelioration of the symptoms.
Not infrequently the affection subsides into the chronic form and the abscess, having a restricted channel for evacuation, remains as a suppurating cavity.
Diagnosis. The enlargement and tenderness of the prostate as felt on rectal examination is pathognomonic. If the body of the urine is clear there is further corroboration, as in cystitis it is more or less turbid and flocculent or even bloodstained. Micturition is likely to be much more frequent in cystitis than in prostatitis. Catheterization is much more painful when the catheter passes the prostate in prostatitis than in cystitis.
Prognosis is always grave. Some cases recover completely, while others run on to a fatal termination, and still others merge into the chronic form. Cases that are complicated by abscess are always to be dreaded, as chronic suppuration, or pelvic or peritoneal infection, or pyæmia, or septic poisoning is liable to supervene. As the disease is more common in the old so it is liable to prove more severe and redoubtable.
Treatment. In acute cases active derivation toward the bowels is desirable. A mercurial purge (calomel—horse or bull 1 to 2 drs.; dog, 2 to 5 grs.) may be followed a few hours later by salines (sodium sulphate—horse or bull 1 lb.; dog 1 oz.). Sodium sulphate or magnesium sulphate may also be given with glycerine as an enema. Great benefit may often be obtained from the application of leeches on the perineum or around the anus. The diet must be restricted and non-stimulating, mainly of amylaceous materials, and with the water, flaxseed tea may be liberally mixed. When the suffering is severe it may be met by camphor, camphor bromide, ergot, hamamelis, gelsemium or potassium bromide, given by the mouth or rectum. With violent strangury, opium, belladonna or hyoscyamus may be used. Some cases may be relieved by the use of enemata of cold water or pieces of ice in the rectum. In retention of urine, careful catheterization is imperative, the hand or finger in the rectum being employed to guide the point of the catheter under the prostate.
In case of abscess an opening by the side of the anus is preferable to one by the urinary passages or rectum, and will obviate the danger of rupture into the peritoneum. A pasty or fluctuating swelling in the perineum should be incised until the pus flows. A tense elastic fluctuating prostate may be transfixed by a cannula and trochar from the side of the anus, guided by the hand or finger in the rectum. When the pus has been evacuated a drainage tube may be inserted through the cannula and left in place when the latter is removed so as to allow free drainage at all times and frequent antiseptic injections. Punctures and even incisions have been made from the rectum, but they make badly infected wounds, and a rupture into the urethra, determines infection on that side, without any possibility of any effective antiseptic injection or perfect drainage. As injections may be used permanganate of potash 1:10000, or boric acid, a saturated solution. Poisonous agents must be eschewed or used with the greatest circumspection.